Acid Erosion: An Increasingly Relevant Dental Problem. Risk Factors, Management and Restoration

Health effects of drinking 100% juice: an umbrella review of systematic reviews with meta-analyses

CONTEXT

Low fruit and vegetable intakes are major modifiable determinants of disease. One hundred percent juice may facilitate intake and deliver essential nutrients and bioactive compounds. However, the position of 100% juice in healthy eating guidelines remains controversial due to its lower dietary fiber and higher free-sugar contents compared with whole fruits and vegetables.

OBJECTIVE

To conduct an umbrella review of systematic literature reviews with meta-analyses (MAs) to summarize the health benefits of drinking 100% fruit and/or vegetable juice.

DATA SOURCES

Four databases (Medline, The Cochrane Library, EMBASE, and CINAHL) were systematically searched for MAs of 100% juice and any health outcomes.

DATA ANALYSIS

Screening, quality, risk of bias, and content overlap tools were applied, and extracted data were narratively synthesized. No eligible studies for vegetable juice were found. Fifteen systematic literature reviews (51 primary MAs, 6 dose-response, and 87 subanalyses; 50-1200 mL/day; hours to years of duration) were included. Ten MAs (19.6%) reported health benefits (4 for blood pressure, 2 for vascular function, 3 for inflammation, 1 for stroke mortality), 3 MAs (5.9%) reported adverse risks (1 each for cardiovascular disease mortality, prostate cancer, type 2 diabetes risk), while most (74.5%) reported no effect (blood lipids, body composition, liver function, metabolic health, cancers, and inflammation). Risks were limited to cohort studies and benefits were found in both cohort and intervention studies.

CONCLUSION

The findings collate evidence showing some potential health benefits associated with 100% juice consumption, with fewer potential risks. The balance of evidence does not support the exclusion of 100% juice from food-based guides to healthy eating, although caution may be warranted in certain groups or individuals, and the body of evidence is not yet conclusive.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022380588.

Sublingual/Buccal buprenorphine and dental problems: a pharmacovigilance study

BACKGROUND

The association between dental problems and sublingual/buccal buprenorphine is unclear. We conducted an analysis of dental adverse drug reactions reported with sublingual/buccal buprenorphine in VigiBase®, the pharmacovigilance database of the World Health Organization.

RESEARCH DESIGN AND METHODS

We performed disproportionality analyses to compare the reporting rates of dental problems with sublingual/buccal buprenorphine, compared to other buprenorphine formulations and methadone. Significant signals were considered if the lower boundary of the 95% confidence interval of the Reporting Odds Ratio (ROR) was > 1; cases were ≥ 3 and p-value <0.05. We conducted sensitivity analyses by calculating the ROR according to the reporter's qualification and the reporting continent (United States of America and Europe).

RESULTS

We included 30,769 reports with all buprenorphine forms. We found 20 cases of dental problems with sublingual/buccal buprenorphine. Sublingual/buccal buprenorphine was associated with an overreporting of dental problems compared to other buprenorphine formulations (ROR = 15.10; 95% CI [7.50-30.39]; p < 0.005) and compared to methadone (ROR = 6.02; 95% CI [3.21-11.30]; p < 0.005). Overreporting of dental problems was consistent in sensitivity analyses, except in Europe compared with other buprenorphine formulations and with methadone.

CONCLUSIONS

Sublingual/buccal buprenorphine might increase the risk of reporting dental problems. However, these results do not modify the benefits of sublingual/buccal buprenorphine in the treatment of opioid use disorders.

Effect of mouth rinses on tooth enamel surface

This study aims to evaluate the effect of mouth rinses on the color, microhardness, and surface roughness of tooth enamel. Sixty dental blocks were collected from human third molars and divided in five groups (n = 12): the control group (CG) without immersion in mouth rinse, Listerine Zero, Colgate Plax Fresh Mint, Listerine Whitening, and Colgate Luminous White. The groups were subjected to initial color analysis; the microhardness and roughness of the enamel surfaces were evaluated. Next, the samples were subjected to immersion in mouth rinses or brushing with conventional fluoride toothpaste (CG) according to the manufacturer's instructions; after a 12-week treatment, the color, microhardness, and roughness were once again assessed and compared with the initial analysis. Data were tabulated and analyzed through a two-way analysis of variance (ANOVA) (color and roughness) followed by Tukey's test. Microhardness was analyzed through the Kruskal-Wallis test followed by Dunn's test; the level of significance was 5%. All groups immersed in mouth rinses had a higher level of microhardness loss than CG; additionally, all groups showed changes in the enamel surface. Enamel surface loss was observed using a roughness test, and the mouth rinses promoted a higher level of color changes than CG. Given the results, it can be concluded that the mouth rinses led to significant changes in tooth enamel.

Antierosive Effect of Topical Fluorides: A Systematic Review and Meta-Analysis of In Situ Studies

BACKGROUND

The effectiveness of the application of topical fluorides in prevention of erosive tooth wear has been an issue of controversy in the literature. The objective of this systematic review was to assess in situ studies investigating the effects of using topical fluorides on prevention of erosive tooth wear.

MATERIAL AND METHODS

Two electronic databases PubMed/MEDLINE and Cochrane Central Register of Controlled Trials were searched. Eligibility criteria included in situ-controlled studies that assessed the effect of the erosive process without additional tooth brushing. The search involved English-written articles only. A total of 684 potentially relevant titles and abstracts were found after removal of duplicates, of which 22 full-text articles were selected. Seventeen studies were included in the qualitative synthesis of which 6 studies included in the meta-analysis. The following data were obtained for each study: authors, year of publication, country, study design, periods of study, duration, blinding, interventions (type/concentration/form), tooth substrate, location of the intraoral appliance, number of samples attached to each appliance, type of acidic media used for erosive challenge, duration of erosive challenge, subjects (number/age/sex), reported side effects -if any-, measuring device, amounts of tissue loss.

RESULTS

The risk of bias of the included studies was assessed using the Cochrane Collaboration tool for assessing the risk of bias. A meta-analysis of the present study was performed using Comprehensive Meta-Analysis version 2.2.048 software.

CONCLUSION

The use of oral hygiene products containing AmF/NaF/SnCl2 or NaF may be effective in the prevention of erosive tooth wear.

In vitro quantitative comparison of erosive potential of infant mouthwashes on glass ionomer cement

Background

The widespread use of mouthwashes, specially in children, is a concern, since the long-term use may modify the topography of dental materials. However, this process still unclear regarding the wear related to infant mouthwashes on glass ionomer cement. Thus, the purpose of this investigation was evaluate the erosive potential of infant mouthwashes on glass ionomer cement specimens.

Material and Methods

Forty round-shaped specimens were divided into 4 groups (N=10) and submitted to erosive cycling for 15 days, being exposed 2X/day in the following children’s active agents mouthwash solutions: G1- cetylpyridinium chloride, G2- xylitol and triclosan and G3 - Malva sylvestris and xylitol. Prior to cycling, the specimens were submitted to the surface roughness measurement. After erosive cycling, the specimens were reanalyzed, and calculated the increase of roughness (∆Ra). Additionally, it was adopted distilled water as a negative control (G4). As an extra analysis, the mouthwashes had their pH values measured. The results were submitted to T-test and ANOVA followed by Tukey test at 5%.

Results

In relation to pH values, G2 presented the most acidic pH value (pH = 6.83) in comparison to other substances. Regarding the comparison of the final roughness values (R) among the groups, it was verified that the mouthwashes showed significant roughness increase in comparison to control group, especially to G3 group (Rf = 1.67 ± 0.14) as well the ΔRa values with statistical difference in comparison to distilled water. Still, with exception of control group outcome, an increase of roughness of each mouthwash was verified after the studied period.

Conclusions

Active agents present in infant mouthwashes were capable of roughness increased of glass ionomer cement surface, demonstrating an erosive potential of this material largely used in pediatric dentistry.

Key words:Dental erosion, dental cements, mouthwash.

Management of dental erosion induced by gastro-esophageal reflux disorder with direct composite veneering aided by a flexible splint matrix

Dental erosion is frequently overlooked in clinical practice. The management of erosion-induced damage to the dentition is often delayed, such that extensive occlusal rehabilitation is required. These cases can be diagnosed by a careful clinical examination and a thorough review of the patient's medical history and/or lifestyle habits. This case report presents the diagnosis, categorization, and management of a case of gastro-esophageal reflux disease-induced palatal erosion of the maxillary teeth. The early management of such cases is of utmost importance to delay or prevent the progression of damage both to the dentition and to occlusal stability. Non-invasive adhesively bonded restorations aid in achieving this goal.

Efficacy of different strategies to treat root dentin eroded by liquid or gaseous hydrochloric acid associated with brushing abrasion

OBJECTIVE

This study aims to evaluate how casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) associated with Nd:YAG or Diode laser affects dentin exposed to hydrochloric acid (HCl) with or without tooth brushing.

DESIGN

One hundred and sixty human root dentin blocks were selected after they were initially eroded with liquid HCl (pH 1.2) 3x for one day. The blocks were divided into the following groups: G1- liquid HCl (HCl-l), G2- HCl-l + brushing, G3- gaseous HCl (HCl-g), and G4- HCl-g + brushing. Each group was randomly assigned to the following treatments (n = 10): A) Control (no treatment), B) CPP-ACP, C) CPP-ACP associated with Nd:YAG laser (λ = 1064 nm) (40 mJ, 10 Hz, 0.4 W, 15 s), and D) CPP-ACP associated with Diode laser (λ = 980 nm) (0.5 W, 200 μs, 15 s). The treatment with CPP-ACP (G2, G3 and G4) was applied on the dentine surface for 5 min. Erosion (6x/day/20 s) and erosion (6x/day/20 s) with abrasion (2x/10 s) were performed for five days. Dentin volume loss was determined by 3D confocal laser microscopy. Data were analyzed with two-way ANOVA and Tukey's tests.

RESULTS

G1 - CPP-ACP (10.77 ± 1.66) and CPP-ACP associated with Diode laser (9.98 ± 0.89) showed lower volume loss in relation Control group (12.86 ± 0.63) (p < 0.05). G2 - CPP-ACP associated with Diode laser (12.41 ± 1.08) elicited lower volume loss as compared to the Control (14.42 ± 1.24) (p < 0.05). As for G3 and G4, all treatments showed similar volume loss.

CONCLUSION

CPP-ACP and CPP-ACP associated with Diode laser could control dental tissue loss in dentin eroded by liquid HCl. Moreover, CPP-ACP associated with Diode laser could effectively decrease dental tissue loss in dentin exposed to liquid HCl and brushing.